Psychopathology AO3

What are the 4 definitions of abnormality

• Failure to function adequately

• Statistical infrequency

• Deviation from social norms

• Deviation from ideal mental health

Describe statistical infrequency

• According to the statistical infrequency definition of abnormal behaviour is that which is rare and different statistically (anomalous)

Statistical infrequency +VE Evaluation

• Useful in diagnosis - e.g. intellectual diability disorder which requires an IQ in the bottom 2%

Statistical infrequency -VE Evaluation

• Some rare behaviours are actually desirable, e.g. IQ over 150 is classed as abnormal but is desirable. Some common behaviours, e.g. depression, are actually not desirable. Therefore, it fails to distinguish between desirable and undesirable behaviours

• Cultural relativism - what is classed as rare in one culture is not classed as rare in another Therefore, cant us’t use the same definition for all cultures - imposed etic

• The cut-off points are subjective - many factors to mental health are subjective, and it is hard to define mental illness solely on stats

Describe deviation from social norms

• According to the deviation from social norms definition of abnormality, abnormal behaviour is that which is different from how we expect people to behave

• Norms are specific to the culture we live in. Social norms change over time (e.g. homosexuality was considered abnormal in our culture in the past and is still considered abnormal in some cultures) and in cultures, so few behaviours are universally considered abnormal.(However, psychopathy is viewed as universally abnormal as it ’s a failure to conform to lawful and culturally normative behaviour)

Deviation from social norms +VE Evaluation

• RWA - helps diagnose anticocial personality disorder as it is a failure to conform to sociatal norms

Deviation from social norms -VE Evaluation

• Situationally bound - Wearing a costume for halloween is not seen as abnormal but wearing one to work is . Breaking social norms is not necessarily a deviation from social norms e.g someone shouting as a one off immediately apologised compared to someone that is always shouting. therefore, social deviance on its own is not a complete explanation for abnormality, it needs to be paired with context

• Culturally bound - A person form one culture may label someone from another culture as abnormal using their standards rather than the persons standards e.g. hearing voices is socially acceptable in some cultures but would be seen as a sign of abnormality in others

• Change over time - Social norms aren’t consistent - homosexuality- it requires context and time period. it is only relevant in the historical period it is used in

• Harmful - used to outlaw unwanted behaviour. In Russia , anyone who didn’t conform to the state where placed in a mental institution and classed as having a mental illness. Therefore, if we define mental illness in terms of deviation from social norms, there is a danger of creating definitions based off prevailing social morals and attitudes

Describe failure to function adequately

• According to the failure to function adequately definition of abnormality, abnormal behaviour is that which is defined as not being able to cope with everyday life i.e. go about tasks like sleeping, eating, going to school, hygiene.

• The individual or others around are distressed

Failure to function adequately -VE Evaluation

• Some people may choose to live off the grid and not socialise with anyone and that would be classed as abnormal and their freedom of choice is restricted

• It can be normal - e.g when you are grieving you may be not functioning adequately. However failure to function adequately is real despite the circumstances. Someone grieving may need professional help. This means its hard to know when to base a judgement of abnormality on failure to function. It depends on the situation and duration

Describe deviation form ideal mental health

• According to the deviation form ideal mental health definition of abnormality, abnormal behaviour is that fails to meet criteria for psychological normality

Deviation from ideal mental health +VE Evaluation

• Includes a wide range of criteria for mental health. This means that mental health can be discussed meaningfully with a range of professionals ie. it is well understood as it covers many areas. it therefore provides a checklist that we can assess ourselves HOWEVER, Jahoda’s checklist is highly unrealistic. According to this criteria, most people will be classed as having a mental illness. It is also very hard to measure things on the criteria such as self-growth. The fact that we cant meet this criteria could be seen as a good thing as it can help reduce the stigma around mental health. Maybe not fulfilling the criteria will be seen as ordinary

Deviation from Ideal mental health -VE Evaluation

• Culture bound - self-actualisation is more of an individualist culture thing that collectivist where they promote the needs of a group rather than themselves. if we apply this to people of other cultures, there would be a high number of mental illnesses which may not be the case

Define phobia

An irrational fear of an object, place or situation. The extent of the fear is disproportionate to the phobic stimulus

What are the behavioural characteristics of Phobias

• Panic - crying, screaming, running away from phobic stimulus

• Avoidance - effort to avoid phobic stimulus - can affect everyday life

• Endurance - Remaining with the phobic stimulus and continuing to experience anxiety

What are the emotional characteristics of Phobias

• Anxiety - unpleasant state of high arousal, prevents relaxation and being able to experience positive emotion

• Fear - immediate response when encountering phobic stimulus

• Emotional response is disproportionate to threat of phobic stimulus

What are the cognitive characteristics of Phobias

• selective attention - finds it hard to look away from phobic stimulus may be adaptive as it gives you the best chance of reacting to a threat

• Irrational beliefs - no basis in reality

• Cognitive distortions - inaccurate and unrealistic

What are the emotional characteristics of depression

• Lowered mood - feeling sad, lethargy, describe themselves as worthless

• Lowered self-esteem - can be extreme e.g. self-loathing

• Anger - aggression that can be directed to self or others e.g. self-harm

What are the behavioural characteristics of depression

• lowered activity levels - reduced energy, may not be able to get out of bed

• Disruption to sleep and eating behaviour - can change in either direction ie for more or less insomnia or hypersomnia

• Agression and self-harm - irritability

What are the cognitive characteristics of depression

• Poor concentration - find simple decision making difficult, unable to stick with task. likely to affect school

• Dwelling on the negative - pay more attention to the -ve and ignore the +ve. Bias towards recalling the -ve events

• Absolutist thinking - black and white thinking. Any bad thing is seen as an absolute disaster

What are the emotional characteristics of OCD

• Anxiety and distress - obsessive thoughts are unpleasant and frightening, and the anxiety that goes with these can be overwhelming

• Lowered mood / depression - compulsions can be very time consuming and can cause a lack of enjoyment

• Guilt and disgust/ shame and self-loathing - insight into irrationality may cause embarrassment, shame and disgust that may be directed to self

What are the behavioural characteristics of OCD

• Compulsions - repetitive actions to help people deal with obsessive thoughts. They temporarily relieve anxiety caused by obsession

• Avoidance - avoiding situations that may trigger anxiety, e.g. avoiding bins because they have germs

What are the cognitive characteristics of OCD

• Obsessive thoughts - persistent intrusive thoughts which cause intense anxiety e.g. worries about being contaminated with germs

• Cognitive coping strategies - hyper vigilance - focus attention source of anxiety. Meditation

• Aware of irrationality - They are aware their behaviour is irrational

What is the 2 process model of phobias

1. Initiation - classical conditioning - UCS triggers a fear response - e.g. little Albert . The fear is generalised

2. Maintenance - operant conditioning -VE reinforcement

2 process model of phobias +VE Evaluation

• Research support for bad experiences - study found that 73% of dental phobias had experienced a trauma most likely involving dentistry which provides evidence of a link between bad experiences and phobias. Further support cam from the control group with low dentist phobias where only 21% had experienced a traumatic event, Therefore this confirms that the association between stimulus and UCR does lead to phobia HOWEVER not all phobias occur due to bad experinces .e.g snake phobias still occur in populations where very few people have any experiences of snakes (may be adaptive). Also not all bad experiences lead to phobias e.g. getting bitten by a dog doesn’t mean you’ll develop a phobia of dogs. Therefore it is not a complete explanation for all cases of phobias

2 process model of phobias -VE Evaluation

• Ignores cognitive aspects - ignores irrational beliefs and only focuses on behaviour - This means the 2 process model doesn’t fully explain the symptoms of phobias

What is systematic desensitisation (SD)

• Behavioural therapy

• counterconditioning

• 1. Anxiety hierarchy - List of situations involving phobic stimulus from least to most anxiety inducing. Put together by the patient and the doctor so is specific to each person

• 2. Relaxation - Therapist teaches Ps relaxation techniques. Based on reciprocal inhibition - one emotion prevents another. Cant be anxious and relaxed at the same time

• 3. Exposure - Patients exposed to phobic stimulus as the bottom of the hierarchy when relaxed and only move up stages when fully relaxed at previous stage

• goes on for several sessions

• Success if relaxed at higher levels of hierarchy

What is Flooding

• Immediate exposure to phobic stimulus with no gradual buildup

• Without the option of avoidance, the person cant -vely reinforce the phobia

• they realise the phobic stimulus isnt harmful

• Takes one or two long sessions

• Not unethical but is unpleasant so Ps need to give informed consent

SD +VE evaluation

• Research support - Research followed up on 42 people with arachnophobia. They were less fearful than the control group. This shows the benefits of SD

• Doesn’t require or understanding on a cognitive level so is good for people with learning disabilities and isn’t as traumatic as flooding making it the most appropriate treatment for some people

• Use of virtual reality which is cost-effective and avoids dangerous situations e.g. heights. HOWEVER the lack of realism makes it less effective. this means VR is sometimes but not always appropriate. It is able to address all phobias easily as some things e.g. getting spiders may be hard to obtain

Flooding +VE Evaluation

• Cost-effective - doesn’t require many sessions. More people can be treated if they can afford it

Flooding -VE Evaluation

• Traumatic - Research shown that both Ps and Therapist find flooding more stressful than SD. Ethical issues about knowingly causing stress. Traumatic nature leads to higher attrition rates (drop-out) than SD

What are the 2 cognitive explanations of depression

• Becks -ve triad - always look at the -ve aspects of things. They have a -ve self-schema which could be acquired during childhood. They look at everything about themselves -vely. They have a -ve view of the world, themselves and their future

• Ellis’ ABC model - A- Activating event e.g. failing and exam. B- Beliefs e.g. irrational i must do well in my test otherwise i’m worthless. Always having a belief to success is musterbation. C - consequences - depression

Beck +VE Evaulation

• Clark and Beck - concluded that cognitive vulnerabilities e.g faulty informational processing and -ve self-schema are more common in depressed people. Study of 473 adolescents found that early cognitive vulnerability predicted later depression. Shows an association between cognitive vulnerability and depression

Beck -VE Evaluation

• Reductionist - only focusses on cognitive aspects. It ignores the biological factor. Neurotransmitter e.g. serotonin play a major role. Better to take an interactionist approach when explaining depression

Ellis +VE Evaluation

• Helped in effective treatment of depression. REBT can help change -ve beliefs and relieve symptoms of depression.

Ellis -VE Evaluation

• Only explains reactive depression- only explains depression when caused by a -ve activating event. However, in many cases, it is not obvious what triggers depression. This means the model can only explain depression in some cases

• Some irrational beliefs may not actually be irrational; instead, they may just be realistic. Evidence shows that depressed Ps make more accurate estimates of the likelihood of disaster - depressive realism. This undermines the validity of the explanation

What is CBT

• Cognitive behavioural therapy

• Challenges -ve irrational thoughts and tries to change behaviour so it is more effective

• The client is the scientist. They are encouraged to test the reality of their irrational beliefs through homework e.g. make a note of when someone was nice to them.

• In future sessions, if the client says no one is nice to them, the therapist can produce this evidence to prove the client wrong

How does Beck relate to CBT

• CBT aims to identify -ve thoughts about self, world, and future which are parts of Beck’s -ve triad

What is Ellis’s REBT

• Extends ABC model D- Dispute and E - effect

• Challanges irrational thoughts - Empirical - is there any evidence to dispute irrational belief - logical - is there any logic to the irrational belief

• Behaviour activation - encouraged to engage in activities they have withdrawn from

CBT +VE Evaluation

• Research support - March compare dthe effects of CBT with antidepressants and a combination of both. After 36 weeks, 81% of the CBT and antidepressant group and 86% of the combination group were significantly improves. Good choice of treatment as it is as effective as drugs but is more cost effective so is 1st choice for treatment. However it is most effective in combination

• Any instances when it appears to be less effective are possibly due to the fact that the client may not be doing/engaging with their homework or the therapist competence accounts for variability in effectiveness. There may also be a bad therapist client relationship so therapists need to be trained effectively

CBT -VE Evaluation

• Individual differences - more suitable for some people more than others. Less suitable for high levels of persistent irrational beliefs. Also less suitable when the 'irrational beliefs' are a realistic reflection on the stressors the person is experiencing

• Requires commitment from client (some people do not want to do the homework)- might be too much cognitive effort for them

• Therfeore it is not a fix-all solution- need to consider patient choice in amongst effectiveness

• Relapse rates are high. assessed every month for 12 months after completing CBT course. 42% relapsed within 6 months and 53% relapsed within a year

• Therefore it is not a long term fix. Perhaps refresher courses are required on annual basis. That is expensive

What does the COMT gene do

• Reduce levels of DA

• In people with OCD, their variation of the COMT gene lowers its activity, so there are high levels of DA

What does the SERT gene do

• Lowers serotonin levels

Genetic explanations of OCD -VE Evaluation

• Diathesis-stress. Study where over half of people with OCD experienced a traumatic event. There was a +VE correlation with OCD and trauma. Shows how environment influences OCD it is not purely genetic. Reductionist

• Not as straightforward as inheriting a gene so you develop OCD. You can inherit the vulnerability which may or may not develop into OCD

• Polygenic - not caused by a single gene

Genetic explanations of OCD +VE Evaluation

• Research evidence - 68% MZ twins had OCD compared to 31% DZ twins. Supports role of genetics

What 2 hormones are involved in OCD

• High levels of DA

• Low levels of serotonin

Explain the neural explanations (correlates) of OCD

1. Caudate nucleus normally supressed signals from Orbitofrontal cortex (OFC) that sends signals to the thalamus about worrying things

2. When the caudate nucleus is damaged it fails to supress minor worry signals and the thalamus is alerted

3. This then sends signals back to the OFC acting as a worry circuit

4. Serotonin is linked to the OFC and caudate nucleus

5. Dopamine is linked to Basal ganglia. High levels of DA can lead to overactivity in this area

neural explanations (correlates) of OCD +VE Evaluation

• Research support - Role of Serotonin supported by use of anti-depressants. HOWEVER aetiology fallacy - just because serotonin works doesn’t mean the lack of it causes OCD like taking paracetamol for a headache doesn’t mean the lack of paracetamol causes the headache

neural explanations (correlates) of OCD -VE Evaluation

• High rates of co-morbidity - OCD + Depression. SSRI’s might relieve the depression rather than OCD

Examples of Drug therapies for OCD

• SSRI’s - Selective serotonin reuptake inhibitor e.g Fluoxetine - prevent the reabsorption of S in presynaptic neurone so it increases S in the synapse. It then continues to stimulate post synaptic neurone so S level are now high

• Clomipramine - older SSRI’s but more severe side effects

Drug therapies for OCD +VE Evaluation

• Review of studies - all studies showed better outcomes following SSRI’s than placebo. However may not be the most effective treatment. CBT may be more effective.

• Cheap and easy. Don’t require many sessions like CBT. Non disruptive in peoples lives

Drug therapies for OCD -VE Evaluation

• Serious side effects - nausea, headaches and insomnia. Tricyclic have worse side effects like hallucinations. Some drugs can cause addiction so can be used for 4 weeks at a time. Therefore less people are willing to take the drugs and may reduce their quality of life instead of making it better